Harnett James T, Dargan Paul I, Dines Alison M, Archer John R H, Greene Shaun L, Hunter Laura J, Wood David M
Emergency Department, University College London Hospitals NHS Foundation Trust, London, UK
Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Emerg Med J. 2022 Jun;39(6):463-466. doi: 10.1136/emermed-2020-209550. Epub 2021 Oct 14.
Methamphetamine is a stimulant drug of abuse with increasing prevalence of use worldwide leading to public health concern. While previous research by our group a decade ago found no evidence of increasing harms associated with methamphetamine use in the UK, there are conflicting data on whether or not this is still the case. This paper aims to identify trends in methamphetamine-related harms and characterise the clinical features of ED presentations involving methamphetamine with gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL).
We retrospectively interrogated a database of all toxicology-related presentations to two central London EDs, extracting data on drugs involved for presentations relating to methamphetamine between 2005 and 2018 to enable analysis of trends. Further clinical data were extracted for presentations between 2014 and 2018 to give a 4-year case series.
A total of 1244 presentations involving the use of methamphetamine were identified. The number of presentations rose from 4 in 2005 (1.9% of all recreational drug presentations) to 294 (16.2%) in 2018. A total of 850 cases were identified for the 2014-2018 case series, 94.9% were male with a median (range) age of 35.1 (16-67) years. The most common clinical features in the methamphetamine presentations were neuropsychiatric: agitation (41.5%), anxiety (35.2%), hallucinations (16.5%) and psychosis (14.8%). GHB/GBL was co-used in 54.2% of presentations and appeared to attenuate the neuropsychiatric features seen. Use of GHB/GBL was associated with a higher Poisoning Severity Score and requirement for level 2/3 (high dependency unit/intensive care unit (ICU)) care.
ED attendances in central London relating to methamphetamine use have risen over the last decade. Combining methamphetamine with GHB/GBL is common and is associated with a higher Poisoning Severity Score and need for ICU level care. Further work is required to establish whether further resources need to be directed at this clinical and public health problem.
甲基苯丙胺是一种滥用的兴奋剂药物，在全球范围内的使用 prevalence 不断增加，引发了公众健康担忧。尽管我们团队十年前的研究没有发现英国与甲基苯丙胺使用相关危害增加的证据，但关于情况是否仍然如此的数据存在冲突。本文旨在确定与甲基苯丙胺相关危害的趋势，并描述涉及甲基苯丙胺与γ-羟基丁酸/γ-丁内酯（GHB/GBL）的急诊科就诊的临床特征。
我们回顾性查询了伦敦市中心两家急诊科所有与毒理学相关就诊的数据库，提取了2005年至2018年期间与甲基苯丙胺相关就诊中所涉及药物的数据，以便分析趋势。还提取了2014年至2018年期间就诊的进一步临床数据，形成一个4年的病例系列。
共识别出1244例涉及使用甲基苯丙胺的就诊病例。就诊病例数从2005年的4例（占所有娱乐性药物就诊病例的1.9%）增至2018年的294例（16.2%）。2014 - 2018年病例系列共识别出850例病例，94.9%为男性，中位（范围）年龄为35.1（16 - 67）岁。甲基苯丙胺就诊病例中最常见的临床特征为神经精神方面：躁动（41.5%）、焦虑（35.2%）、幻觉（16.5%）和精神病（14.8%）。54.2%的就诊病例中同时使用了GHB/GBL，且似乎减轻了所观察到的神经精神特征。使用GHB/GBL与更高的中毒严重程度评分以及对2级/3级（高依赖病房/重症监护病房（ICU））护理的需求相关。
在过去十年中，伦敦市中心与甲基苯丙胺使用相关的急诊科就诊人数有所上升。甲基苯丙胺与GHB/GBL联合使用很常见，且与更高的中毒严重程度评分以及对ICU级护理的需求相关。需要进一步开展工作以确定是否需要针对这一临床和公共卫生问题投入更多资源。
